The 5 New Pharmacy Care Models

By: Perry Cohen, Chief Executive Officer, The Pharmacy Group

U.S. healthcare had quite a year in 2018. Employers, the federal government, and patients are not happy with the way healthcare is delivered and financed. Hospitals, physicians, and pharmacies try to remain relevant as new technologies are developed to commoditize healthcare services and enable patients to become true consumers.

Pharmaceutical companies continue to improve healthcare with new therapeutic agents. The value of these new drugs can benefit society, but even more so, their impact on healthcare economics is staggering. Specialty drugs to treat certain patients present new challenges for health plans and pharmacy benefit managers (PBMS).

As pharmaceuticals grow to consume 30% of the healthcare dollar, traditional care models need to change in order to deliver the best healthcare outcomes and real value or they will become obsolete.

In the future, drugs covered under the medical benefit, many of which are specialty drugs, will need new systems and processes to manage these drugs administered through the physician office, home infusion, and hospitals.

Current and new models

This creates a need for new care models.

The current care models in pharmacy are:

Community (e.g., CVS and Walgreens)

Hospital (e.g., Cedars-Sinai)

Long-term care (e.g., Omnicare)

Mail order (e.g., CVS and Express Scripts)

Specialty (e.g., Diplomat).

These models are: facility driven by site of care, healthcare-professional driven, expensive, and inefficient.

The key shortcomings of the current care models are that they:

Do not use a population health approach to identify the patients to treat

Make the patient come to the site of care (e.g., hospital, pharmacy, or physician office) to receive care

Additionally, online retailer Amazon, is disrupting the current business model in the retail and grocery industries and will do the same in the community pharmacy industry.

This will give employers and the federal government new choices in how healthcare is delivered. However, they will need a digital health strategy to leverage these new services to make sure the sickest patients can be treated in the patient care setting that can deliver measurable health outcomes improvement.

As a result, there will be new benefit designs and ways to finance care.

By tpg-admin|2019-01-23T16:40:03+00:00January 23rd, 2019|Blog|Comments Off on The 5 New Pharmacy Care Models